| Score | Frequency | |
| How many times do you typically urinate from waking in the morning until sleeping at night? | 0 | 7 or less |
| 1 | 8 - 14 | |
| 2 | 15 or more | |
| How many times do you typically wake up to urinate from sleeping at night until waking in the morning? | 0 | 0 |
| 1 | 1 | |
| 2 | 2 | |
| 3 | 3 or more | |
| How often do you have a sudden desire to urinate, which is difficult to defer? | 0 | not at all |
| 1 | less than once a week | |
| 2 | once a week or more | |
| 3 | about once a day | |
| 4 | 2 - 4 times a day | |
| 5 | 5 times a day or more | |
| How often do you leak urine, because you cannot defer the sudden desire to urinate? | 0 | not at all |
| 1 | less than once a week | |
| 2 | once a week or more | |
| 3 | about once a day | |
| 4 | 2 - 4 times a day | |
| 5 | 5 times a day or more |